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Topics:
Health
Healthy
Boston Builds Strong Communities
Healthy Boston
is a bold and innovative initiative that focuses on making things
happen in communities in an inclusive and collaborative manner.
The vision for Healthy Boston was to use a 6 million dollar fund
to help self-identified communities within the city establish
coalitions, define their own needs, use their own resources better,
and be in a stronger position to negotiate with the city government
and other outside agencies regarding resources and services.
Case study plus.
Index
Case Study Plus: Healthy Boston Builds
Strong Communities
Contents
Introduction
Chapter 1: Summary of Key Findings
Chapter 2: Evaluation Methodology
Chapter 3: Description of Healthy Boston - History
Case
Study Plus: Healthy Boston Builds Strong Communities
Healthy
Boston Evaluation
Final Report Evaluation Team:
Roberta Miller, Marsha Morris, and Mary Skelton
Submitted
to: Office of Community Partnerships, Healthy Boston, Boston,
MA
Submitted
through: Roberta Miller and Associates, Watertown, MA
May
15, 1996
Introduction
Healthy Boston
is a bold and innovative initiative that focuses on making things
happen in communities in an inclusive and collaborative manner.
The vision for Healthy Boston was to use a 6 million dollar fund
to help self-identified communities within the city establish
coalitions, define their own needs, use their own resources better,
and be in a stronger position to negotiate with the city government
and other outside agencies regarding resources and services. The
city took an enormous risk in moving ahead with the Healthy Boston
initiative, committing itself to a level of community self-definition
and control that was unprecedented. The initiative provoked a
substantial amount of criticism, particularly from those who were
not committed to the values of inclusion, collaboration, and community
control or who doubted Healthy Boston's commitment to those values
and a new way of doing business.
The evaluation
process was specifically designed as a way to learn. Boston was
trying something new; it was one of the first cities in the country
to undertake a Healthy Cities Project. No Healthy Cities Project
had yet gone through an evaluation process. The evaluation was
conceived as a way to learn how to best implement a project of
this scale, give feedback throughout the project, help educate
the different constituencies about the nature of the initiative
and opportunities it presented, and help other cities in similar
efforts.
Because
the vision of Healthy Boston was so sweeping, almost all interviewees
could list some shortcoming of the initiative. The evaluation
team recognized that the process of coalition building and redefining
modes of cooperation among city government, residents, agencies,
and institutions is complex and gradual, where success is often
uneven and not evident for many years. The team did not consider
it fair or useful to judge the success of the initiative on whether
Boston's way of doing business has been transformed within the
last four years, because clearly it has not. Rather, the analysis
of the evaluation looks at some of the broad brush accomplishments
and disappointments based on the six goals of the initiative and
the overall implementation of Healthy Boston. The body of the
evaluation includes the following five chapter topics: a summary
of key findings, the evaluation methodology, a history of the
initiative, an analysis of the six goals and an implementation
assessment, and the evaluation team recommendations. The final
two chapters focus on the individual coalitions. Chapter 6 includes
profiles of the 8 first-round coalitions and their respective
communities, and chapter 7 is a listing of the accomplishments
of all the Healthy Boston coalitions. It is the hope of the evaluation
team that the findings will inform further development in Boston
and in the ever increasing national and worldwide Healthy Cities
movement.
Chapter
1: Summary of Key Findings
Accomplishments, Weaknesses, and Recommendations
Summary
of Accomplishments
Healthy Boston
has supported the development of 21 coalitions within the city.
19 of those coalitions, though somewhat modified from their original
configuration, continue to serve their communities and meet Healthy
Boston requirements for funding.
The Healthy
Boston initiative has helped raise substantial new external funds
for the coalitions' programmatic activities including millions
of dollars from the Casey, Pew, and Boston Foundations and new
federal and state moneys for education and youth anti-crime activities.
Coalitions are seen as viable and desirable vehicles for city,
state, federal, and foundation funded projects.
Healthy
Boston coalitions have improved the coordination of services within
the Healthy Boston neighborhoods. Member agencies and institutions
have changed. All have built stronger relationships on which further
work can develop and some have collaborated on delivering services
and identifying gaps within the community.
Some Healthy
Boston agency and institutional members have changed the way they
deliver services to be more sensitive to the experience and needs
of residents. The forum of Healthy Boston has allowed those agencies
and institutions to learn more about their ever changing community
and alter their activities accordingly.
Healthy
Boston has implemented several successful citywide efforts which
have addressed such issues as ESL study groups, window guards
for children, insurance for low income children, neighborhood
health data, and community/police relations.
The coalition
network provided a valuable and effective way to "get the word
out" to community groups and residents. At the coalition coordinator's
business meetings, many city, state, federal, private and nonprofit
departments organizations were able to present information that
could be shared and disseminated by the coalition coordinators
to their coalitions.
The coalitions
have been instrumental in developing local leadership and increasing
diverse and inclusive community participation through their activities
and programs.
The central
staff of Healthy Boston has remained flexible, creative, and supportive
to the coalitions with their eyes set firmly on the principles
of Healthy Boston. When coalition development was not working
or a particular group did not want to associate formally with
Healthy Boston, coalitions were supported in their efforts to
reinvent themselves.
Healthy
Boston has provided very effective training to the coalitions
which has greatly enhanced their development.
All coalitions
have accomplished something addressing the quality of life in
their communities. Many have accomplished a great deal.
Coalitions
serve as a negotiation table for diverse communities. Various
stakeholders have come together to negotiate their differences
and to develop a common agenda. Communities now have a vehicle
to define their own resources and needs, which are separate from
the influence and agendas of outside funders.
Healthy
Boston has a national presence and is a national leader in the
Healthy Cities movement.
Healthy
Boston exists as an initiative, continuing to develop strength
and learn from its mistakes. Through two administrations and many
leadership changes, Healthy Boston has survived and continues
to develop, change, and educate people in all sectors on the value
of collaboration and of working directly with the community in
an inclusive environment.
Summary
of Weaknesses
Insufficient
support has been provided for struggling coalitions.
The city
and Healthy Boston's efforts have not been coordinated in a way
that would optimize the political and collaborative nature of
each.
Healthy
Boston needs additional support from the funding community to
further its goals.
Summary
of Recommendations
The city
should make a policy commitment at the highest levels to the next
iteration of Healthy Boston.
More resources
should be allocated to assist community-based coalition development
with clear behavioral expectations that are negotiated by all
parties.
Leadership
development and inclusive resident involvement should continue
to be the primary focus for coalitions.
More time,
long-term attention, and creativity of approach is needed in areas
where community members perceive their neighborhoods to be relatively
unsafe.
Chapter
2: Evaluation Methodology
The evaluation
team has been guided by several principles in the development
and implementation of the evaluation.
Those
being evaluated or affected by the initiative inform the process.
In a series
of roundtable discussions, Healthy Boston staff, coalition coordinators,
community representatives, and the funding community helped identify
evaluation guidelines, important questions, and Healthy Boston
goals. (The guidelines and compilation of the initial questions
are included in the appendix.)
The evaluation
team then established a steering committee made up of Healthy
Boston and city staff, a former coalition coordinator, several
community representatives, a local funding agent, a member of
the Mayor's cabinet, and a member of the city's mid level management
team to offer guidance throughout the evaluation process. The
role of the steering committee, which has met five times, has
been to review and offer feedback to the team on the evaluation
design, the research tools, and information gathering approaches,
to help generate the list of people important to the initiative
to be interviewed, and to review the draft report.
The
evaluation is shaped by program goals.
Although
the goals have been articulated in many different ways and have
shifted in emphasis throughout the life of the initiative, the
following are the Healthy Boston goals on which the steering committee
agreed and the evaluation is based:
- to create
vehicles (community coalitions) for collective community voice
and action;
- to create
a new kind of partnership between the community and city government;
- to serve
as a catalyst to increase collaboration
- among
city departments,
- among
agencies, institutions, organizations, and residents
to improve
services and optimize resources;
- to embrace
a set of values, encouraging work that is community-based and
empowering, collaborative, multicultural, and inclusive;
- to embrace
a vision of "health" that goes beyond the medical definition
to encompass economic development, housing, education, and employment
as well as the broader issues of community fabric;
- to improve
the quality of life in Boston neighborhoods.
The
purpose of evaluation is to learn.
The evaluation
team believed that the most useful evaluation would be iterative:
coalitions and central staff would receive feedback during various
phases of the evaluation process. This approach provided Healthy
Boston and the coalitions with the opportunity to make improvements
during the course of the evaluation. The evaluators conducted
training and informational sessions for the coalition coordinators
on the evaluation process. Coalitions received informal feedback
and assistance based on the evaluator's observations. The team
also conducted in-depth feedback sessions with the Healthy Boston
staff. The evaluation team prepared preliminary findings and recommendations
for the initiative in June of 1995 to further discussions for
improvement of Healthy Boston and to assist in the strategic planning
process.
Quantitative
and qualitative data are both important.
Because
of the comprehensive and multilevel nature of the Healthy Boston
Initiative, the evaluation team developed a constellation of assessment
tools to look at the initiative in three areas: the city government,
the coalitions, and the communities. Both process and outcome
information for each of those areas were identified. Because of
the relatively short duration of the initiative (2-3 years at
the time of the evaluation), long-term community health impact
data, like crime and health statistics were not analyzed. The
team was also very dependent on self-reporting since the evaluation
did not begin until the beginning of the 3rd year of a 4 year
project. There was no way to establish a baseline picture of the
participating communities. The following matrix identifies the
various tools that the team has used. (Major tools are included
in the appendix.)
Healthy
Boston Evaluation Process
Flow chart
not available on-line.
Historic
timeline
In June of 1994, while developing the guidelines for the evaluation,
the evaluators asked the stakeholder groups to identify key events
in the development of Healthy Boston. These events were plotted
on a timeline to provide a graphic representation of events which
was used in introducing the process to constituents and as the
basis for the narrative history of the report.
Quarterly
activity logs
Each coalition completed activity logs as part of the city's tracking
of the coalition activities. The evaluation team had access to
these logs.
Observation
of select coalition meetings and events
An evaluation team member was assigned to each coalition and attended
a number of monthly community coalition meetings and key coalition
sponsored events.
Regular
updates with Healthy Boston staff
An evaluation team member met regularly with a Healthy Boston
central staff member to keep informed of citywide and central
office activities and changes.
Observations
of the monthly coalition coordinators' business meeting
A member of the evaluation team attended monthly coalition coordinators'
business meetings to keep appraised of important city and coalition
developments.
Survey
coalition membership
In the spring of 1995, a membership survey was administered to
coalition members at their regular meetings with some members
completing them later and returning them to the evaluation team.
The survey was designed to get the regular members' assessment
of coalition activities and operations, their perception of the
coalition's benefit to the community, and the effect the coalition
experience has had on them. A total of 204 surveys were completed.
Coordinator
interviews and follow-up focus groups
The coalition coordinators and leadership were interviewed early
in the evaluation process (fall of 1994) and follow-up focus groups
were conducted in June of 1995.
Interviews
with independent community observers
For each coalition, 3 knowledgeable community members were interviewed
about the role and benefit the coalitions have had in their respective
communities. One was a city employee working in the neighborhood,
second was a knowledgeable community activist selected by the
coalition leadership for their balanced perspective on the coalition,
and the third was an active participant in the neighborhood selected
by the evaluation team for their knowledge of the community and
the coalition.
Interviews
with Healthy Boston staff
Interviews were conducted with Healthy Boston staff to identify
specific strengths and barriers of the initiative from the staff's
perspective.
Focus
group of participants in implementation projects
Two coalitions received implementation moneys from Healthy Boston
and completed their projects by the end of the evaluation. Focus
groups were conducted with the participants of these projects:
LINCS in Allston/Brighton and Positive People in Codman Square.
The final round of implementation projects were funded in September
of 1995 and, therefore, started too late for this evaluation process.
Key
city staff interviews
In order to understand the impact that Healthy Boston has had
on the way the city bureaucracy functions, a set of interviews
was conducted with key city staff. The interviewees were identified
by the evaluation steering committee.
Community
and coalition profiles
Recognizing that each coalition was unique, the evaluation team
chose not to develop a few in-depth case studies of the 21 coalitions,
but to develop shorter profiles of the 8 first-round coalitions
and their communities. The profiles include a community description,
community demographics, the coalition membership's perceptions
of the community based on standard ratings, what coalition members
perceived to be indicators of coalition success, and a short assessment
of the coalition's development and activities.
The community
descriptions and demographics were gathered from a variety of
statistical sources within the city. The community perception
data was gathered at regular coalition meetings or, in some cases,
with a smaller subset of the coalitions. The evaluation team helped
the coalitions develop and rate their own indicators for success
and develop a consensus on how they perceived their communities.
In order to get a common understanding of coalition members' perception
of each community, the evaluation team developed a set of 21 questions
based on the National Civic League's Civic Index and Harvard Professor
Robert Putnam's concept of social capital. 17 of the questions
allowed for a numerical rating with comments and 4 were open-ended.
The negotiated responses to the questions give a snapshot of how
coalition members describe their community on specific measures
of civic infrastructure strength. (The community perception questions
and community responses are included in the appendix.)
Chapter
3: Description of Healthy Boston - History
Initiative
Development
Healthy
Boston emerged from the parallel development and eventual merging
of two separate series of events - one local and the other international.
In Boston, Judith Kurland, who served as the Commissioner of the
Department of Health and Hospitals for the City of Boston between
1988 and 1993, observed that Boston's service delivery system
was overly bureaucratic, and, while many of social and health
related programs were aimed at the same populations, there was
little coordination among providers resulting in the duplication
and inefficiency of services. She also noted that health issues
in a community were greatly impacted by other community issues
well beyond those traditionally considered "health" issues. The
initial impetus for Healthy Boston came from some basic principles,
set out by Commissioner Kurland, which included the following:
communities themselves were best equipped to identify their own
needs and priorities; categorical funding makes it very difficult
to address community needs holistically; and, finally, collaboration
rather than competition between agencies and organizations would
support better utilization of resources in communities. Although
Ms. Kurland's job implied a primary focus around physical "health,"
she had a bigger vision for Boston that included "health" in the
broadest sense of the word.
In early
1990, Commissioner Kurland established a "visioning group" comprised
of Department of Health and Hospital's staff (DHH) and charged
them with constructing a "blueprint" that would:
- facilitate
collaboration and integration of human services at the local
and neighborhood level;
- encourage
communities to partner with local government to define and work
on addressing their own priorities;
- restore
some of the social and civic infrastructure that make communities
viable, strong, and healthy; and ultimately,
- lead to
improved quality of life for Boston residents.
In the summer
of 1990, with a general framework completed, an advisory committee
of city department heads and community leaders was formed. The objective
was to get support for the initiative by consulting influential
city hall and community stakeholders early on in the process. The
key players were so successful at generating city government interest
in the concept that it became the focus of the city department heads'
December 1990 retreat. As a result of this retreat, the Human Services
Cabinet was established to support the development, implementation,
and coordination of the initiative among city departments. [1]
In 1984
and unbeknownst to Commissioner Kurland, the World Health Organization
(WHO), sponsored the International Healthy Cities Conference in
Toronto, Canada, which marked the beginning of an international
movement to empower and provide residents a voice in improving
the quality of life in their neighborhoods. The international
movement continued to develop. After the Boston's project was
well on its way, local proponents learned of the WHO efforts and
recognized their shared goals.
A "Building
Health Through Community" conference was held in April of 1991
to publicly introduce Boston's vision for a healthy city. The
conference proved seminal in many ways. The name "Healthy Boston"
surfaced as a viable one for the initiative. A set of recommendations
emerged from that conference, which outlined an action plan for
a Healthy Boston initiative. A formal link was established between
Boston's effort and the larger international healthy cities movement.
And, finally, one particularly notable presenter from Cali, Columbia
spoke of enormous progress that was made in their rapidly growing
and impoverished community. Following up on that contact, a trip
was arranged with private funding which allowed several Healthy
Boston staff and coalition members to visit Cali in the winter
1993. The visitors witnessed firsthand some remarkable accomplishments.
Cali residents, with assistance from local government, had established
their own commercial center, unemployment rates were steadily
decreasing and, most important, residents were becoming less reliant
on government to meet their basic needs. These successes further
inspired the development of Healthy Boston.
Shortly
after the conference, an opportunity arose to secure funding for
Healthy Boston. Boston City Hospital became eligible for enhanced
funding from the US Department of Human Service's (DHH) Medicaid
program because of the disproportionately high number of hospital
patients with incomes below the poverty level. A total of $18
million dollars was available from the federal government to the
Department of Health and Hospitals; DHH was required to design
a comprehensive plan to spend the money as part of the State Medicaid
Plan. DHH was awarded the funding, $6 million of which was earmarked
for community based prevention activities and evolved into Healthy
Boston.
Ted Landmark,
Jerry Mogul, and Aldalberto Texiera were transferred from DHH
and other city departments to manage and coordinate Healthy Boston
functions. This team and its support staff, with Ted Landsmark
as Executive Director, constituted the Healthy Boston central
office. Central staff worked alongside several key city and neighborhood
residents to define the scope and requirements for Healthy Boston.
Healthy
Boston was officially announced in August of 1991 by Boston Mayor
Raymond Flynn. Within three months, DHH hosted a series of community
meetings on the initiative. The meetings provided Healthy Boston
staff with important information on how to develop the "Request
For Application" (RFA) which was scheduled for November 16th of
1991. That meeting, which was called to explain the draft RFA,
drew over 300 people who were planning to respond. The RFA set
several requirements for applicants to meet in the course of the
first year. As well as creating an inclusive environment for diverse
residents, applicants were to: (1) establish themselves as coalitions
with representation from at least five sectors of the community
including health, education, economic development, housing, and
human services; (2) identify a community-based organization or
agency to serve as fiscal agent to the coalition; (3) conduct
a community assessment identifying important community needs,
resources, and issues; (4) hire a coalition coordinator; (5) develop
an action plan that outlined the coalition strategies, models,
and plans for development; and (6) articulate a special project
that demonstrated the ability to draw on all their coalition partners
to implement. The performance of these activities comprised the
basis for minimum standards for coalitions in the initiative.
At that
time, the Healthy Boston process was envisioned as two cycles
of funding plus additional funding for implementation grants for
community projects within a three year period. In fact, the initiative
stretched over four years and four funding cycles. In the first
round, neighborhoods were allowed to apply for funding based on
the current development of their communities. Neighborhoods that
had not coalesced at all could apply for technical assistance;
recently formed coalitions could apply for planning grants; and
existing coalitions could apply for planning grants on a "fast
track" to begin implementation sooner. Technical assistance or
pre-planning grants could be used to assist neighborhoods in getting
coalitions formed. Planning grants were available for initial
coalition establishment and development. Coalitions were free
to use these funds for activities such as structuring meetings,
hiring technical assistance to conduct their assessments or for
any activity that would help establish the coalition. Continuation
grants were provided once the coalitions had completed their prescribed
planning activities. These grants were to support ongoing coalition
operations and activities such as paying the coalition coordinator's
salary and conducting smaller activities and events. Implementation
funds were to support the more advanced coalitions in the implementation
of their community-based demonstration project. A community review
panel, made up of knowledgeable community representatives, city
employees, and other knowledgeable citizens, was set up to evaluate
the applications and to determine what level of funding each coalition
should receive based on an assessment of their development.
Coalition
Formation and Funding History
The first round
of applications for Healthy Boston funding were received in February
of 1992. The first awards were announced in July of 1992. This initial
funding cycle launched the start of financial support that, by 1995,
included preplanning, planning, technical assistance, bridge, continuation,
conditional, and implementation funding. Twenty seven proposals
were submitted and twenty received some level of funding. Eight
coalitions received planning grants. They were: Allston-Brighton,
Codman Square, Columbia Point, Chinatown, Egleston Square, Jamaica
Plain, Lower Roxbury, and Upham's Corner. (Community and coalition
profiles of these 8 round-one coalitions can be found in the final
section of this report.) Nine other coalitions were awarded preplanning
grants which could be used for technical assistance and other start-up
activities. They were: Charlestown, Chinatown, East Boston, Franklin
Field/Franklin Hill, Field's Corner/Meeting House Hill/Bowdoin Street
(FMB), Greater Mattapan, Mission Hill, South End/Lower Roxbury,
and Gay, Lesbian, Bi-Sexual Transgender Youth (GLBTY). [2]
Three additional coalitions were awarded technical assistance moneys.
They were: Hyde Park, South Boston, and West Roxbury. This meant
that the eight coalitions which received planning grants were eligible
to apply for implementation funding while the others would have
to resubmit their applications for the next planning grant funding
cycle. [3] Two of the coalitions
- FMB and Mission Hill - requested that they be considered fully
functioning coalitions even though they had not received planning
grants. FMB and Mission Hill agreed to be up to speed within the
year, which would enable them to apply for implementation grants.
Central office agreed to the requests, bringing the number of fully
functioning coalitions eligible to apply for implementation grants
to ten. At the end of this first round of funding, a new coalition,
the Grove Hall Coalition, formed and became eligible for the second
planning grant funding cycle.
The Healthy
Boston office indicated to the coalitions that, over the life
of the initiative, funds would be available for approximately
eight or nine implementation projects. Whereas planning and continuation
grant awards had been based purely on meeting certain criteria,
implementation grant awards were competitive and limited. The
first applications for implementation projects followed the second
funding cycle. The continuation award decisions were made by the
review panel and announced in June of 1993. In addition to the
ten fully functioning coalitions, seven partially funded coalitions
and four new applicants were awarded continuation grants. By the
summer of 1993, Healthy Boston had twenty-one active coalitions.
Along with
the distribution of continuation funds, the implementation awards
were also announced in July of 1993. Five out of the ten eligible
coalitions applied for the available grants. Of the five entrants
only Allston-Brighton's Leadership to Improve Neighborhood Communication
and Services (LINCS) project was awarded $225,000 to begin its
implementation project. The project's focus was to develop leadership
and community organizing skills in linguistic minorities from
the Allston-Brighton community.
The four
other coalitions were asked to revise and resubmit their proposals.
Codman Square, Jamaica Plain, Roslindale, and Upham's Corner completed
the task the following month. The Codman Square Healthy Boston
Coalition was awarded the second implementation grant for their
Positive People Program. This program was a youth training program
which focused on the rehabilitation of a community building. Because
of delays caused by the transition in mayoral administrations
and the unclear status of Healthy Boston at that time, Codman
Square received its $225,000 grant six months after the review
panel met and recommended the project. [4]
New applications
for "Operating Grants," Funding Cycle III went out in May of 1994.
Operating grants were awarded to all the coalitions except the
Franklin Field/Franklin Hill, Grove Hall, and Jamaica Plain coalitions
which were defunded. Franklin Field and Grove Halls' funds were
put in escrow for use by the community. The Jamaica Plain coalition
was defunded with the recommendation that the coalition merge
with the local Boston Against Drugs (BAD) team and the Human Services
Committee of the Jamaica Plain Neighborhood Council.
By the Fall
of 1994, another coalition, Greater Mattapan, was defunded. This
now meant that three coalitions - Franklin Field, Grove Hall,
and Mattapan - which represented some of the poorest neighborhoods
in Boston, were unable to meet the minimum Healthy Boston requirements
and had been defunded. The city, recognizing it could not abandon
these communities, granted the coalitions special status which
enabled them to restructure themselves into what became known
as the "Blue Hill Avenue Corridor." The central office, with support
from local elected representatives, went after a large federal
grant to assist in the reorganization of these coalitions. Although
they did not receive the grant, $105,000 in Healthy Boston funds
were set aside to assist this new coalition. The central staff
was able to raise an additional $40,000 from the United Way, with
the Federal Regional Office for Health and Human Services contributing
an additional $6,500 to aid in the reorganization effort. In March
of 1995, a new coordinator was hired by the central staff to facilitate
the Blue Hill Avenue Corridor coalition development.
At about
the same time as the Blue Hill Avenue Corridor coordinator was
hired, the Healthy Boston office announced that it would open
its final funding, Cycle IV, "Strengthening Partnerships and Resident
Participation," for continuation funds. This time the RFP process
was open to BAD coalitions as well as Healthy Boston coalitions.
[5] The Request for Proposal
for Fiscal Year 1996 went out in May of 1995.
Seven coalitions
were given provisional funding [6]
and all of the remaining coalitions received full operational
funding except Upham's Comer, which was defunded. Upham's Corner's
funds were put in escrow for the community for future use. A surprise
addition to the awards in June of 1995 was the refunding of the
Jamaica Plain Coalition. Jamaica Plain had followed and met the
original provisions given it almost a year prior. Additionally,
they had successfully merged with JP BAD and the Human Service
Committee of the Jamaica Plain Neighborhood Council, and now had
a new resident constituency base to target their efforts. All
this had been accomplished by the coalition with no Healthy Boston
funds.
Following
the final funding cycle, Healthy Boston called for new implementation
proposals in July of 1995. Thirteen coalitions were eligible to
apply, eight applied, and three projects were chosen for funding.
Egleston Square Coalition's Project, Breathe Easier, was designed
to address the need for prevention and early identification of
asthma in the Egleston Square community. Several of the coalition's
partners, including the local health center, will implement this
health project. The Chinatown project focuses on supporting communication
between youth and adults through parenting skill development,
health outreach, and social/recreational activities. The GLBTY's
Safe Homes Project focuses on finding foster parents and providing
assistance and support systems for gay and lesbian youth who have
been evicted from their homes.
Political
Environment
Throughout
the period of coalition formation and growth there have been major
city leadership changes and regular bureaucratic problems that
affected the development of the initiative. Although Healthy Boston
had the initial, though not enthusiastic, support of Mayor Ray
Flynn, the initial grants were awarded four months later than
planned because of city budget questions. During this time the
real vision and high level support for the initiative resided
in Judith Kurland, Commissioner of the Department of Health and
Hospitals.
After the
first year of operation, in July of 1993, Commissioner Kurland
resigned and was replaced by Larry Dwyer. This started a two year
period of turmoil and turnover for city government. Also in July
of 1993, Mayor Flynn left office for a diplomatic position at
the Vatican. Thomas Menino became the acting mayor until the following
January. Menino won the fall election and continued as the Mayor.
Menino spent several months gathering his leadership team following
the election. Along with the predictable Flynn to Menino staff
transitions, several key people left the administration for other
jobs including Larry Dwyer, Commissioner of Public Health; Alyce
Lee, Chief of Staff for the Mayor; Alonzo Plough, Deputy Commissioner
of Public Health; and Ann Maguire, Chief of Health and Human Services.
Ann Maguire's position was left vacant for several months. Because
of these changes, Healthy Boston was without clear administrative
policy level support at several points. Often the central staff
of the initiative were unable to answer basic questions about
the future of the initiative because of changes in political control
and leadership vacancies. During this time they were in the position
of waiting for new leadership to assess Healthy Boston and fit
it into broader policy changes.
This transition
period damaged the credibility of the central staff because of
continued delays in decisions on the awards of implementation
projects, lack of clear administrative policies, and the apparent
absence of overall citywide administrative support of the initiatives
objectives. Coalitions were pushing for clear messages from the
city which were not forthcoming. The evaluation was also delayed.
Consultant selection interviews were held in August of 1993, but
the evaluation team was not notified to begin work until June
of 1994.
Some initial
steps toward coherent policy direction started in the late spring
of 1994 when the Mayor moved the initiative out of DHH and into
the Office of Safe Neighborhoods, which was placed under the new
Health and Human Services Cabinet. In a move to further consolidate
and streamline the city's community coalitions, Boston Against
Drugs and Healthy Boston were moved to the same office space and
explored ways to collaborate and support their mutual missions.
It was not until January of 1995, after a long period of "indecisiveness"
and the submission of a formal proposal by the frustrated coalitions,
that a decision was made to extend continuation grants. This decision
allowed the initiative to continue another year, but it meant
that funds would probably not be available for as many implementation
projects. (As noted earlier, three smaller scale implementation
grants were eventually awarded in July of 1995.) During the summer
of 1995, the Office of Safe Neighborhoods was renamed the Office
of Community Partnerships to better reflect the overall goals
of the office.
Outside
Funding
In addition
to the initial 6 million in federal dollars originally secured to
fund the Healthy Boston effort, the central office staff involved
the initiative in local and national demonstration projects. This,
in turn, meant that more funds were brought into the coalitions
and their neighborhoods. These projects also increased the visibility
of the Healthy Boston initiative on the local, national, and international
fronts. (A complete list of the major grant awards are listed in
Chapter 4 under Goal 2 of Healthy Boston outcomes.)
Citywide
Projects
The original
goals of Healthy Boston included citywide efforts as well as individual
coalition development and work. Over the past 3 years, Healthy Boston
contributed funding to three major citywide efforts and participated
in three others. Healthy Boston started to be recognized as a useful
vehicle for other city initiatives to link to communities.
The first
initiative, in the summer of 1993, was "Kids Can't Fly," a window
guard program. This campaign, done in collaboration with the Department
of Health and Hospitals, was developed in response to the crisis
of accidental falls by children that summer.
The second
initiative, was a new state funded project to enroll children
without health insurance into a no/low cost health insurance plan.
In October 1994, Healthy Boston coalitions joined in partnership
with Health Care for All and the Mayor's Health Line to conduct
outreach to enroll eligible children for this program. The program
was temporarily discontinued because of limited state funding,
but reopened in the fall of 1995.
Healthy
Boston kicked off its third citywide project in September of 1994.
"Speak Easy" was designed to enhance the English skills of the
thousands of people on waiting lists for ESL classes. This project
was sponsored by the Healthy Boston office and initiated by Mayor
Menino. In the first year, Health Boston contributed $40,000 to
the program to develop a new health focused curriculum with Boston
ESL providers. The "Speak Easy" curriculum was made for television
and was shown on the city's cable municipal channel and BNN. Video
tapes were made available for study groups organized through the
Healthy Boston coalitions as well as by other sites throughout
the city including churches, community centers, and local businesses.
In February
of 1995, another initiative, sponsored by the Conference of Boston
Teaching Hospitals, the League of Community Health Centers, the
Massachusetts Department of Public Health, and the Boston Department
of Health and Hospitals (DHH) approached the Healthy Boston initiative
about participating in its citywide "Health Data Rollout." This
project was to inform and educate the community about the latest
DHH city health statistics. Issues such as infant mortality, the
incidence of various health problems, and other important health
statistics were compiled by neighborhood. This educational effort
was designed to help communities be more aware of health related
trends in order to focus their efforts on current and emerging
problems.
Though no
formal relationship was ever forged, Healthy Boston coalitions
played a role in the Boston Police Department's Strategic Planning
Process. Coalition representation was evident at many of the district
meetings in this process. Since much of the police department's
process relied on participation of community leaders, the strong
representation of coalition members signified the important role
that the coalitions played in many neighborhoods.
Training
A major component
of Healthy Boston has been the training and technical assistance
offered to coalition coordinators and members. From the outset,
the central staff has sponsored and encouraged continued training
as a key part of the coalitions' and the project's development.
The central office contracted with World Education and the Boston
Prevention Center to offer ongoing technical support to all the
coalitions. Throughout the initiative, the central staff also introduced
the coalitions to various technical innovative approaches to serving
their communities.
The first
training organized by the central staff was held in the Fall of
1992. This training came shortly after the first disbursement
of preplanning and planning grants. The training helped participants
begin organizing and developing their coalitions based on the
goals and objectives of Healthy Boston. Along with this training,
a visioning process was organized in December of 1992 as the first
coalition-wide forum. The central staff again encouraged coalition
exchange and input to inform the Healthy Boston development process.
Even during
the period of political instability, central staff continued to
provide training and support for coalition coordinators through
monthly coordinators' meetings, topic-specific training and regular
support from central office staff. In June of 1993, the central
staff organized a multicultural development training for all coalitions.
And within two months of that training, in August of 1993, the
staff held a series of retreats which helped set new priorities
for the 93-94 fiscal year.
In order
to ensure that the coalitions were in line with the goals and
objectives of Healthy Boston, a training for new coordinators
was conducted in January of 1995 as a way to deal with the significant
turnover in coalition staff This training was held to orient the
coordinators on the role of the coalitions as well as the ideals
and goals of the Healthy Boston movement. Shortly before that
training in November of 1994, the Healthy Boston initiative, with
the central staff, coalition representatives, and internal and
external partners, began its own strategic planning process. This
process was initiated to plan and execute a strategy for the initiative's
future once the fourth and final funding cycle was completed.
Healthy
Cities Movement
As one of the
first major US cities to initiate a Healthy Cities project, Boston
has served a leadership role in the Healthy Cities movement. Both
Judith Kurland and Ted Landsmark are nationally recognized spokespersons
and thinkers in the movement. The coalitions and staff have offered
valuable guidance to other communities in the development of the
initiative.
Healthy
Boston has shared its experience in a variety of local, state,
national and international forums. Since 1993 Boston has been
a site for National Civic League's leadership development program.
Also, in 1993, Healthy Boston participated in the Healthy Cities
Conference held in San Francisco, California. The Fall of 1994
brought two unique opportunities for Healthy Boston Program to
play an important role in the international and national movement.
In October of 1994, Healthy Boston cosponsored with U.S. AID a
conference entitled, "Lessons Without Borders." Following this
event, the Healthy Boston central staff, coalition staff, and
evaluation team made presentations at the National Civic Leagues'
Healthy Cities Conference in November 1994.
Notes
1.
The Human Services Cabinet later became known as the inter-departmental
team. The team met until the fall of 1993.
2.
All the Healthy Boston coalitions are geographically defined communities
except the Gay, Lesbian, Bisexual, and Transgender Youth coalition,
which is a Boston-wide community based on sexual orientation.
The Chinatown coalition, though geographically defined, serves
a wider Asian community throughout the city.
3.
By the second year, July 1993, all of the applicants resubmitted
their applications and were approved by the review panel except
South Boston. The South Boston coalition was rejected and asked
to resubmit by the review panel, but they chose not to resubmit.
4.
During this period, Healthy Boston had to provide bridge funding
to several coalitions which had run out of funding so that they
could keep functioning until May.
5.
Boston Against Drugs (BAD) was already being overseen by Ted Landsmark
from the former Office of Safe Neighborhoods, which also housed
Healthy Boston. Although more limited in scope than Healthy Boston,
BAD's goals clearly overlapped with many of Healthy Boston's.
6.
0f the 7 coalitions provisionally funded, five of them were approved
for full funding in November 1995. West Roxbury was defunded,
and Lower Roxbury was extended with additional conditions.
Index
Introduction
Chapter 1: Summary of Key Findings
Chapter 2: Evaluation Methodology
Chapter 3: Description of Healthy Boston - History
Chapter 4: Project Outcomes
and Evaluation Findings
Chapter 5: Evaluation Team
Recommendations
Chapter 6: Round-One Community
and Coalition Profiles
Chapter 7: List of Coalition Accomplishments
Appendix A: Evaluation guidelines
and questions
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